Quantitative Echocardiography Improves Resident Assessment of Left Ventricular Systolic Function.

Abstract

The use of echocardiography to assess left ventricular ejection fraction (LVEF) is an important component of anesthesiology resident education; however, there is no consensus on the most effective method for teaching this skill set. This study investigates the impact and feasibility of teaching a quantitative LVEF assessment method to anesthesiology residents, compared with teaching visual estimation techniques. We included all anesthesiology residents rotating through cardiac anesthesia at our institution from August 2020 through March 2021. Participants completed a pretest to assess baseline ability to accurately estimate LVEF. All tests consisted of transthoracic echocardiography images with standard views from 10 patients. Participants were assigned to either a control group that received teaching on visual estimation of LVEF or an intervention group that was taught quantitative LVEF assessment with the Simpson biplane method of discs. After 4 weeks, all participants were administered a postteaching exam. A retention exam was administered an additional 4 weeks later. LVEF accuracy was measured as the absolute difference between their LVEF estimation and the reference value. Control and intervention groups performed similarly on the preteaching exam of LVEF estimation accuracy. Intervention-group residents demonstrated significantly improved accuracy in LVEF assessment on the postteaching exam (3.6% improvement in accuracy, confidence interval [CI], 1.23-5.97; P = .03) compared with the control group (0.60% improvement inaccuracy, CI, -1.77-2.97; P = .62). The observed improvement was not maintained through the retention exam.Conclusions: Addition of quantitative LVEF assessment to traditional teaching of visual LVEF estimation methods significantly improved the diagnostic accuracy of anesthesiology residents' left ventricular systolic function assessment.